Georgia Medicare Extra Help Application: Part D LIS How-to Guide

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By Brevy Care Team · Last verified May 13, 2026

The Medicare Part D Low-Income Subsidy (LIS), commonly called "Extra Help," is one of the most important Medicare benefits for low-income beneficiaries. Established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003, Public Law 108-173) and codified at Section 1860D-14 of the Social Security Act (42 USC 1395w-114), the LIS subsidizes Medicare Part D premiums, deductibles, and copayments for beneficiaries with limited income and resources. Before the Inflation Reduction Act of 2022, LIS came in two tiers: Full LIS (for the lowest-income beneficiaries) and Partial LIS (for moderately low-income beneficiaries). The Inflation Reduction Act of 2022 eliminated the Partial LIS tier effective January 1, 2024, expanding Full LIS to all beneficiaries with income up to 150 percent of the Federal Poverty Level (FPL) and resources within specified limits. The result is that more beneficiaries qualify for the full subsidy, with no donut hole transition tier. For 2026, Full LIS provides: $0 premium on benchmark plans; $0 deductible; low fixed copays (see ssa.gov for current amounts); $0 cost-sharing once the beneficiary reaches the catastrophic coverage threshold. Eligibility is based on income up to 150 percent of the Federal Poverty Level and resources within CMS-specified limits (see ssa.gov for current figures). Some beneficiaries are "deemed" automatically LIS-eligible: Full Medicaid (Full Benefit Dual Eligibles), Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), Qualifying Individuals (QI), and Supplemental Security Income (SSI) recipients. Others must apply through the Social Security Administration or the Georgia Department of Community Health. This guide explains the legal framework, eligibility rules, the application process through SSA Form SSA-1020 and Georgia Gateway, the deemed eligibility automatic enrollment, the documentation needed, the appeal rights when LIS is denied, the annual redetermination process, common application mistakes, and worked examples for typical Georgia LIS applications. :::

::: callout Key takeaways for Georgia Medicare Extra Help application

• The Medicare Part D Low-Income Subsidy (LIS), or "Extra Help," is codified at Section 1860D-14 of the Social Security Act and provides premium, deductible, and copay subsidies for low-income Part D beneficiaries.
• The Inflation Reduction Act of 2022 eliminated the Partial LIS tier effective January 1, 2024, expanding Full LIS to all beneficiaries with income up to 150 percent FPL and resources within limits.
• Income eligibility is based on 150 percent of the Federal Poverty Level; see ssa.gov for current monthly dollar limits.
• Full LIS benefits: $0 premium on benchmark plans, $0 deductible, and low fixed copays (see ssa.gov for current amounts).
• Apply through SSA online at ssa.gov/medicare/prescriptionhelp, by phone at 1-800-772-1213, by paper Form SSA-1020, or in person at a local SSA office.
• Alternatively, apply for Medicaid through Georgia Gateway (1-877-423-4746) since Full Medicaid, QMB, SLMB, QI, and SSI recipients are deemed LIS-eligible automatically.
• LIS is automatically deemed for QMB, SLMB, QI, SSI, and Full Medicaid recipients without separate application.
• GeorgiaCares (SHIP) at 1-866-552-4464 provides free unbiased application help.
• Annual redetermination required; income or resource changes must be reported within 10 days. :::

What is the Medicare Part D Low-Income Subsidy

The Medicare Part D Low-Income Subsidy (LIS), commonly called "Extra Help," is the federal program that subsidizes Medicare Part D costs for beneficiaries with limited income and resources. The program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) as part of the creation of Medicare Part D itself. Congress recognized that the new prescription drug benefit would be unaffordable for many low-income Medicare beneficiaries without a subsidy, and built the LIS into the original Part D statute.

The LIS pays three things on behalf of qualifying beneficiaries. First, it pays the Part D plan premium up to the regional benchmark amount. Beneficiaries enrolled in plans at or below the benchmark pay $0 in premium. Second, it pays the Part D deductible in full, so LIS recipients pay $0 deductible. Third, it caps the cost-sharing on covered drugs at low fixed amounts (see ssa.gov for the current copay schedule). Once the beneficiary reaches the catastrophic threshold, they pay $0 for any covered drug for the rest of the year.

The cumulative value of LIS to a typical recipient can be substantial. A Georgia retiree on a moderate medication regimen might save $1,200 to $2,500 per year through LIS, depending on the specific drugs they take. A recipient on multiple high-cost drugs can save significantly more. For seniors living on Social Security with limited savings, these savings make Part D coverage affordable rather than a major financial burden.

The program is administered jointly by the Social Security Administration (which handles applications and eligibility determinations) and the Centers for Medicare and Medicaid Services (which administers the subsidy through Part D plans). State Medicaid agencies including the Georgia Department of Community Health play a role in deemed eligibility for Medicaid recipients.

Section 11404 of the IRA 2022 and the Full LIS expansion

Before 2024, Medicare Part D LIS had two tiers. Full LIS applied to beneficiaries with the lowest income and provided the most generous subsidies. Partial LIS applied to beneficiaries with moderately low income (between 135 and 150 percent FPL) and provided a smaller subsidy with a sliding-scale premium contribution, a small deductible, and slightly higher copays.

The Inflation Reduction Act of 2022, signed August 16, 2022, included Section 11404, which eliminated the Partial LIS tier effective January 1, 2024. After that date, all beneficiaries with income up to 150 percent FPL and resources within limits qualify for Full LIS. There is no longer a transition tier. The expansion added additional Medicare beneficiaries nationally to Full LIS rolls and simplified the program for those near the income threshold.

The Full LIS expansion is one of the most important consumer-protection elements of the IRA 2022. It simplifies the LIS program (one tier instead of two), provides more generous benefits to those near the income threshold, and reduces the cliff effect that previously existed at the 135 percent FPL line. For Georgia beneficiaries with income between 135 and 150 percent FPL, the expansion was a significant improvement: instead of partial subsidy, they now receive the full subsidy.

Eligibility for LIS in 2026

LIS eligibility depends on two factors: income and resources. Both must be within specified limits. For 2026, the income limit is 150 percent of the Federal Poverty Level, and the resource limit is set at specified dollar amounts published annually by CMS. See ssa.gov for the current year's figures.

Income includes most sources: Social Security retirement and disability benefits, pensions, employment income, interest, dividends, rental income, and most other regular cash income. Income does not include SNAP benefits, certain veterans' benefits, housing assistance, certain medical reimbursements, and a few other specified categories.

Resources are countable assets the beneficiary owns. Resources do not include the primary residence, one vehicle per household, personal effects, household goods, burial spaces, burial funds up to the per-person exclusion, life insurance policies with face value within the exclusion, and income-producing property essential to self-support. See ssa.gov for the current burial fund and life insurance exclusion amounts.

A married couple's eligibility is calculated jointly. Both spouses' income and resources are combined, and the combined total is compared to the couple's limit. Even if only one spouse is on Medicare, the other spouse's income and resources count for LIS determination.

A common question is how Social Security and similar federal benefits are treated. Social Security retirement and disability benefits are countable income. Supplemental Security Income (SSI) is also countable, though SSI recipients are deemed LIS-eligible automatically and don't need to count it. Veterans' disability benefits are countable income (with some exceptions). Pension income, employment income, and most other regular cash income are countable.

Deemed LIS: automatic eligibility for QMB, SLMB, QI, SSI, and Full Medicaid

Certain Medicare beneficiaries are deemed LIS-eligible automatically without needing to apply through SSA. These deemed-eligible groups are:

• Full Medicaid recipients (Full Benefit Dual Eligibles, FBDE)
• Qualified Medicare Beneficiary (QMB) program recipients
• Specified Low-Income Medicare Beneficiary (SLMB) program recipients
• Qualifying Individual (QI) program recipients
• Supplemental Security Income (SSI) recipients

The deemed eligibility framework works as follows. Georgia DCH (or SSA for SSI) determines that the beneficiary is eligible for one of these programs. The eligibility is transmitted electronically to CMS. CMS marks the beneficiary as LIS-deemed in its records. The beneficiary receives a notice of deemed LIS status. If the beneficiary is not already enrolled in a Part D plan, CMS automatically enrolls them in a benchmark plan. The auto-enrollment ensures the beneficiary actually receives the subsidy.

For Georgia beneficiaries who are not already in one of these programs, applying for Medicaid through Georgia Gateway (1-877-423-4746) can be a strategically efficient way to get LIS. A single Medicaid application can yield both Medicaid (typically QMB or SLMB depending on income) and deemed LIS automatically. This approach often produces a more favorable overall result than applying for LIS alone, because the Medicaid benefits include Medicare premium and cost-sharing assistance in addition to the Part D subsidy.

How to apply through the Social Security Administration

For Georgia Medicare beneficiaries who are not deemed LIS-eligible, application is through the Social Security Administration. SSA is the primary application agency for LIS.

Application options:

• Online at ssa.gov/medicare/prescriptionhelp
• By phone at 1-800-772-1213
• By paper Form SSA-1020 (Application for Extra Help with Medicare Prescription Drug Plan Costs)
• In person at a local SSA office (Atlanta, Macon, Savannah, Augusta, Columbus, Athens, and other Georgia locations)

The online application takes approximately 30 minutes to complete. The paper application can be downloaded from ssa.gov and mailed to SSA. In-person application is helpful for beneficiaries who need assistance navigating the questions.

Required information for the application:

• Social Security number
• Bank account information for resource verification
• Tax forms or other income documentation
• Information about household composition (married, single)
• Information about resources (real estate, vehicles, investments, savings)
• Information about Medicare enrollment

Required documentation:

• Social Security card
• Photo identification (driver's license, state ID, passport)
• Bank statements (most recent 3 months)
• Investment statements
• Pension or retirement income statements
• Real estate documentation (deeds, mortgage statements)
• Vehicle titles and registrations
• Income tax returns
• Household composition information

SSA reviews the application, verifies the information, and issues a decision typically within 30 to 60 days. If approved, the beneficiary receives a notice of approval, and the LIS becomes effective. CMS receives the approval from SSA and applies the subsidy through the beneficiary's Part D plan.

How to apply through Georgia Department of Community Health

For Georgia Medicare beneficiaries who might also qualify for Medicaid, applying through Georgia Department of Community Health can be the more strategically efficient path. Medicaid eligibility triggers deemed LIS eligibility automatically.

Application through Georgia Gateway is the recommended online path. Georgia Gateway is the unified public benefit application portal for Georgia, allowing applicants to apply for multiple programs (Medicaid, SNAP, TANF, WIC, and others) through a single application. The website is available in English and Spanish. Phone application is available at 1-877-423-4746.

In-person application is also available through local Division of Family and Children Services (DFCS) offices. Each Georgia county has at least one DFCS office. Many offer extended hours to accommodate working applicants.

The Medicaid application yields one of several outcomes depending on income and resources:

• Full Medicaid (Full Benefit Dual Eligibility) for the lowest income
• QMB (Qualified Medicare Beneficiary) for higher income/resources
• SLMB (Specified Low-Income Medicare Beneficiary) for moderately higher income/resources
• QI (Qualifying Individual) for moderately higher income/resources
• Medicare Savings Programs in general
• No Medicaid eligibility (apply through SSA for LIS instead)

If the beneficiary is approved for any of these programs, deemed LIS is automatic. CMS receives the eligibility data from Georgia DCH electronically and applies the subsidy.

The Medicaid application typically takes longer to process than the SSA LIS application: 45 days for non-disability cases and 90 days for disability cases. However, the Medicaid application can yield more benefits than LIS alone (such as Medicare Part B premium payment under QMB or SLMB).

Annual redetermination

LIS eligibility is reviewed annually. The redetermination process varies depending on how the beneficiary became LIS-eligible.

For beneficiaries who applied through SSA, SSA conducts an annual review. SSA may request updated documentation. If income or resources have changed materially, eligibility status may change. Beneficiaries should respond promptly to any SSA redetermination request.

For beneficiaries who are deemed LIS-eligible through Medicaid, Georgia DCH conducts the annual Medicaid redetermination. If Medicaid eligibility ends, deemed LIS ends. The beneficiary can apply directly to SSA for LIS if they no longer qualify for Medicaid but still meet LIS income and resource limits.

Status changes during the year must be reported within 10 days. These include:

• Income changes (job change, loss of income, raise)
• Resource changes (inheritance, sale of property, large gift)
• Household composition changes (marriage, divorce, death of spouse)

Failure to report changes can result in overpayment notices and possible recovery action. Reporting changes promptly protects the beneficiary and ensures accurate ongoing eligibility.

Appeals when LIS is denied

When LIS is denied, the beneficiary has the right to appeal. The appeals process for LIS denials is administered by the Social Security Administration.

Levels of appeal:

1. SSA reconsideration (within 60 days of denial)
2. SSA Administrative Law Judge hearing
3. SSA Appeals Council
4. Federal district court

The reconsideration is filed using Form SSA-561 (Request for Reconsideration). The form is submitted to SSA within 60 days of the denial notice. The beneficiary may submit additional evidence at this stage. SSA reviews the case afresh and issues a decision.

If reconsideration is denied, the beneficiary may request an ALJ hearing. The ALJ conducts a more formal review, with the beneficiary entitled to present evidence, call witnesses, and have legal representation. ALJ decisions are typically more thorough and consider new evidence not before SSA at lower levels.

If the ALJ rules against the beneficiary, the beneficiary may appeal to the SSA Appeals Council, and ultimately to federal district court. These higher levels are rarely used in LIS cases because most disputes can be resolved at reconsideration or ALJ.

Free help with LIS appeals is available in Georgia through:

• GeorgiaCares (SHIP) at 1-866-552-4464
• Atlanta Legal Aid Senior Citizens Law Project at 404-377-0701
• Georgia Legal Services Program at 1-800-498-9469

Worked example 1: Margaret 72 Atlanta single LIS applicant

Margaret is a 72-year-old retiree living alone in an Atlanta apartment. Her monthly income is $1,200 from Social Security plus a small pension. Her resources include $8,000 in a savings account, $1,500 in a checking account, no real estate (she rents), and one car worth $5,000.

Margaret learns about Extra Help from her GeorgiaCares counselor (1-866-552-4464). The counselor reviews her income and resources and confirms that she likely qualifies. Margaret applies online at ssa.gov/medicare/prescriptionhelp. The application takes her 25 minutes to complete.

Margaret's monthly income is well below the 150 percent FPL limit for a single individual. Her countable resources (savings plus checking; the car is excluded as the one allowed vehicle) are well below the single individual limit. SSA approves the application within 35 days.

Margaret receives a notice of approval. CMS auto-enrolls her in a benchmark Part D plan with $0 monthly premium. Her 2026 cost-sharing is: $0 deductible, low fixed copays per drug, $0 once she reaches the catastrophic threshold.

Margaret takes lisinopril (generic) for blood pressure and atorvastatin (generic) for cholesterol. Her out-of-pocket costs under LIS are dramatically lower than they would be without the subsidy — saving her an estimated $1,100 to $1,400 per year.

Worked example 2: Robert 75 Savannah deemed LIS via QMB

Robert is a 75-year-old retiree living in Savannah. His monthly income is $1,500 (Social Security plus a small pension). His resources are $8,500 in a savings account. He owns no real estate (he rents) and has no vehicle.

Robert applies for Medicaid through Georgia Gateway. The application reviews him for all relevant programs. Robert's income and resources are within the 2026 Georgia QMB limits.

Georgia DCH approves Robert for QMB. The approval is electronically transmitted to CMS. CMS deems Robert LIS-eligible automatically. CMS auto-enrolls Robert in a benchmark Part D plan if he isn't already enrolled.

Robert receives two notices: one from Georgia DCH confirming his QMB approval (which also provides Part B premium payment and Part A/B cost-sharing protection), and one from CMS confirming his deemed LIS status.

Robert's 2026 cost-sharing is: $0 deductible, low fixed copays per drug, $0 once catastrophic threshold is reached. Robert did not need to file an SSA application; the Medicaid application through Georgia Gateway produced both QMB and deemed LIS.

Worked example 3: Linda 68 Macon LIS denied for assets, appeals with burial exclusion

Linda is a 68-year-old retiree living in Macon. Her monthly income is $1,500 (Social Security). She owns her home (excluded from resources). She has $19,000 in a savings account, plus $1,500 set aside in a separate savings account labeled "burial fund." She has one car worth $4,000.

Linda applies through SSA online. SSA initially calculates her countable resources without applying the burial exclusion, and determines that her resources exceed the annual limit, so SSA denies the application.

Linda contacts GeorgiaCares (1-866-552-4464) for help. The counselor explains the burial exclusion: funds designated for burial expenses (up to the per-person exclusion) are excluded from countable resources. Linda's $1,500 burial fund qualifies for the exclusion if it is properly documented. The counselor helps Linda gather documentation showing the burial fund is a separate, dedicated account.

Linda files a reconsideration with SSA (Form SSA-561) within the 60-day deadline. She submits the burial fund documentation. SSA recalculates her countable resources with the exclusion. After applying the exclusion and adjusting her savings, Linda's countable resources fall below the single individual limit. SSA approves the revised application.

Linda is auto-enrolled in a benchmark Part D plan with $0 premium. The case illustrates the importance of understanding the resource exclusions, particularly the burial exclusion, and the value of GeorgiaCares counseling.

Worked example 4: Charles 73 Augusta couple LIS

Charles and Cynthia are a married couple living in Augusta. Charles is 73 and Cynthia is 70. Both are on Medicare. Their combined monthly income is $2,400. Their combined resources are $25,000 in joint savings and CDs. They own their home (excluded) and one car (excluded as the household vehicle).

Charles and Cynthia apply together through SSA. Their combined monthly income is below the 2026 couple limit (150 percent FPL for a household of two). Their combined countable resources are below the 2026 couple resource limit. SSA approves both Charles and Cynthia for Full LIS.

CMS auto-enrolls both Charles and Cynthia in benchmark Part D plans. They each receive $0 premium, $0 deductible, and low fixed copays per drug.

The couple's annual out-of-pocket cost under LIS is dramatically lower than it would be without the subsidy, saving them an estimated $3,600 to $4,600 per year.

Worked example 5: Patricia 65 Columbus dual MAGI/LIS through Georgia Gateway

Patricia is a 65-year-old newly Medicare-eligible resident of Columbus. She works part-time at a retail store earning approximately $800 per month. She also receives $700 per month in Social Security retirement benefits. Her resources are $6,000 in savings and one car worth $3,000.

Patricia is unsure whether she qualifies for Medicaid, LIS, or both. She visits the GeorgiaCares website and learns that applying through Georgia Gateway can yield both benefits if she qualifies.

Patricia applies through Georgia Gateway. The application screens her for all relevant programs. Her income and resources fall within the QMB threshold for Georgia.

Georgia DCH approves Patricia for QMB. The QMB benefit pays her Medicare Part B premium and protects her from Medicare Part A and Part B cost-sharing. The approval is electronically transmitted to CMS, which deems Patricia LIS-eligible automatically.

Patricia receives both Medicaid QMB benefits and deemed LIS. The single application through Georgia Gateway yielded both. She did not need to file a separate SSA application for LIS.

Patricia's annual savings are substantial across three areas: QMB pays her Part B premium, QMB protects from Part B cost-sharing, and LIS provides $0 Part D premium, $0 deductible, and low copays.

Worked example 6: Henry 72 Athens LIS redetermination

Henry is a 72-year-old retiree living in Athens. He has been on Full LIS since 2024 after applying through SSA. His situation has been stable: $1,400/month in Social Security, moderate savings, one car, rented apartment.

In 2025, Henry's sister passes away and leaves him a $5,000 inheritance. Henry deposits the inheritance into his savings account.

Henry contacts GeorgiaCares to ask whether the change affects his LIS status. The counselor advises him to report the change to SSA within 10 days. Henry calls SSA at 1-800-772-1213 and reports the inheritance.

SSA notes the change. Henry's updated resource total remains below the single individual limit. His LIS eligibility continues.

At the annual redetermination (typically conducted by mail), SSA reviews Henry's income and resources. Both remain within limits. SSA confirms continued Full LIS eligibility.

Henry receives a notice confirming his continued LIS status. He continues to enjoy $0 premium, $0 deductible, and low fixed copays. The case illustrates the importance of reporting changes promptly and the routine nature of annual redetermination when resources stay below limits.

Common mistakes Georgia beneficiaries make

Many Georgia Medicare beneficiaries make avoidable mistakes when navigating LIS. Understanding the rules helps avoid these mistakes.

The first mistake is not applying because they assume they don't qualify. Many seniors with modest Social Security income and limited savings actually qualify. The only way to know for sure is to apply.

The second mistake is confusing LIS with the Medicare Savings Programs. LIS subsidizes Part D (prescription drugs). MSPs (QMB, SLMB, QI) subsidize Part B premiums and Part A/B cost-sharing. Beneficiaries may qualify for both. A single Medicaid application through Georgia Gateway can yield both an MSP and deemed LIS.

The third mistake is not realizing the automatic deemed eligibility for Medicaid recipients. Beneficiaries on Full Medicaid, QMB, SLMB, QI, or SSI are automatically deemed LIS-eligible. They do not need to file a separate SSA application. They simply receive a notice of deemed LIS status.

The fourth mistake is missing the resource exclusions. The home, one vehicle, personal effects, household goods, burial spaces, and designated burial funds per individual are all excluded from countable resources. Many beneficiaries fail to apply these exclusions and assume they have too many resources.

The fifth mistake is failing to report changes within 10 days. Income changes, resource changes, and household composition changes must be reported promptly. Failure to report can result in overpayment notices and possible recovery action.

The sixth mistake is choosing a non-benchmark Part D plan without realizing the premium subsidy may not fully cover the plan's premium. Beneficiaries on Full LIS have $0 premium only on benchmark plans. If they choose a plan with premium significantly above benchmark, they pay the difference.

The seventh mistake is missing the 60-day deadline to appeal a denial. The Social Security Administration allows 60 days from the date of the denial notice to file a reconsideration. Beneficiaries who miss this deadline may lose the right to appeal.

The eighth mistake is not knowing about the IRA 2022 expansion. Before 2024, beneficiaries between 135 and 150 percent FPL received only Partial LIS. After January 1, 2024, all eligible beneficiaries up to 150 percent FPL receive Full LIS. Beneficiaries previously on Partial LIS were automatically transitioned to Full LIS in 2024.

The ninth mistake is not using free help from GeorgiaCares (1-866-552-4464). GeorgiaCares counselors are trained on LIS and can help with applications, appeals, and ongoing eligibility questions.

The tenth mistake is not checking whether any of your drugs are subject to reduced or $0 cost-sharing under the Medicare drug price negotiation program. Check with your Part D plan or pharmacist for your drug's current cost-sharing status.

How Brevy supports Georgia Medicare beneficiaries

Brevy (brevy.com) provides comprehensive Medicare and Medicaid resources for Georgia families. Our state-by-state guides cover the Low-Income Subsidy, Medicare Savings Programs, Part D, drug pricing, vaccines, prior authorization, appeals, and many other topics. We update our content as federal and state rules evolve. Our goal is to be the most trustworthy and up-to-date eldercare resource for American families. For free unbiased counseling on a specific case, contact GeorgiaCares (SHIP) at 1-866-552-4464.

::: accordion Frequently asked questions about Georgia Medicare Extra Help application

What is Medicare Extra Help?

Medicare Extra Help, also known as the Part D Low-Income Subsidy (LIS), is the federal program that subsidizes Medicare Part D premiums, deductibles, and copays for low-income beneficiaries. It is codified at Section 1860D-14 of the Social Security Act and was established by the Medicare Prescription Drug Improvement and Modernization Act of 2003.

What is the difference between Full LIS and Partial LIS?

Before January 1, 2024, LIS had two tiers: Full LIS for the lowest income beneficiaries and Partial LIS for moderately low income beneficiaries. The Inflation Reduction Act of 2022 eliminated the Partial LIS tier effective January 1, 2024. After that date, all beneficiaries with income up to 150 percent FPL and resources within limits qualify for Full LIS.

What are the 2026 income limits for Extra Help?

Income eligibility is based on 150 percent of the Federal Poverty Level. See ssa.gov for current monthly dollar figures.

What are the 2026 resource limits for Extra Help?

Resource limits are set annually by CMS. A burial exclusion per individual applies. See ssa.gov for current dollar figures.

What counts as resources?

Countable resources include cash, bank accounts, stocks, bonds, real estate other than the primary residence, vehicles other than one primary vehicle, and retirement accounts. Excluded resources include the primary residence, one vehicle per household, personal effects, household goods, burial spaces, designated burial funds, and life insurance within the face value exclusion.

How do I apply for Extra Help?

You can apply through the Social Security Administration online at ssa.gov/medicare/prescriptionhelp, by phone at 1-800-772-1213, by paper Form SSA-1020, or in person at a local SSA office. Alternatively, you can apply for Medicaid through Georgia Gateway, since Medicaid recipients are deemed LIS-eligible automatically.

What is the Form SSA-1020?

Form SSA-1020 is the paper Application for Extra Help with Medicare Prescription Drug Plan Costs. It can be downloaded from ssa.gov and mailed to SSA. The application asks about income, resources, household composition, and Medicare enrollment.

What is deemed LIS eligibility?

Deemed LIS eligibility means automatic LIS without separate application. Beneficiaries on Full Medicaid, QMB, SLMB, QI, or SSI are deemed LIS-eligible. CMS receives the eligibility data electronically and applies the subsidy.

Do I need to apply if I am on Medicaid?

No. If you are on Full Medicaid, QMB, SLMB, QI, or SSI, you are automatically deemed LIS-eligible. You will receive a notice of deemed LIS status and be auto-enrolled in a benchmark Part D plan if not already enrolled.

What are the Full LIS benefits in 2026?

Full LIS provides $0 premium on benchmark plans, $0 deductible, and low fixed copays per drug. Once the catastrophic threshold is reached, cost-sharing drops to $0. See ssa.gov for the current copay schedule.

What is a benchmark plan?

A benchmark plan is a Part D plan with a premium at or below the regional benchmark amount. CMS calculates the benchmark annually for each region. Full LIS recipients pay $0 premium on benchmark plans.

What happens if I choose a non-benchmark plan?

If you choose a non-benchmark plan, the premium subsidy may not fully cover the premium. You pay the difference between the benchmark and the plan's actual premium. Many beneficiaries find it more economical to choose a benchmark plan.

How long does the application take?

The SSA online application takes approximately 30 minutes. SSA typically issues a decision within 30 to 60 days. The Georgia Medicaid application through Georgia Gateway typically takes 45 days for non-disability cases and 90 days for disability cases.

What if my application is denied?

You can appeal within 60 days of the denial. File a reconsideration with SSA using Form SSA-561. Further levels of appeal include ALJ hearing, SSA Appeals Council, and federal district court.

Where can I get free help with my application?

GeorgiaCares (SHIP) at 1-866-552-4464 provides free unbiased counseling on LIS applications. Atlanta Legal Aid Senior Citizens Law Project (404-377-0701) and Georgia Legal Services Program (1-800-498-9469) provide free legal representation for low-income beneficiaries.

What is the annual redetermination?

LIS eligibility is reviewed annually. SSA conducts the annual review for SSA-applied beneficiaries. Georgia DCH conducts the annual review for deemed beneficiaries. If income or resources have changed materially, eligibility may change.

What changes must I report?

You must report income changes, resource changes, and household composition changes within 10 days. Reporting promptly protects you from overpayment notices and possible recovery action.

Can I have Extra Help and a Medicare Advantage plan?

Yes. Extra Help applies to Part D coverage, whether in a standalone Part D plan or in a Medicare Advantage prescription drug plan (MA-PD). The MA-PD plan must apply the LIS subsidy to your Part D portion.

What is the Part D out-of-pocket cap?

The Part D out-of-pocket cap limits annual Part D out-of-pocket expenses. LIS recipients typically pay so little out-of-pocket that they rarely reach the cap. The cap exists as a protection, but LIS recipients are protected primarily by the LIS subsidies themselves.

What is the catastrophic threshold under Extra Help?

The catastrophic threshold is the level of Part D drug spending at which the beneficiary's cost-sharing drops to $0. For LIS recipients, the subsidies mean they reach the catastrophic threshold faster due to lower upfront copays.

What is the difference between Extra Help and Medicare Savings Programs?

Extra Help (LIS) subsidizes Part D (prescription drugs). Medicare Savings Programs (QMB, SLMB, QI) subsidize Part B premiums and Part A/B cost-sharing. Many beneficiaries qualify for both. Applying for Medicaid through Georgia Gateway can yield both an MSP and deemed LIS in a single application.

What is Georgia Gateway?

Georgia Gateway is the unified public benefit application portal for Georgia. Applicants can apply for Medicaid, SNAP, TANF, WIC, and other programs through a single application. Medicaid approval triggers deemed LIS eligibility automatically.

Is Extra Help worth applying for if my income is close to the limit?

Yes. Even if your income is close to the 150 percent FPL limit, applying is worthwhile. Resource exclusions may reduce your countable resources below the limit. Free help from GeorgiaCares (1-866-552-4464) can help determine eligibility. :::

Find personalized help applying for Medicare Extra Help at brevy.com.

::: cta Apply for Medicare Extra Help in Georgia

• Social Security Administration 1-800-772-1213
• SSA Atlanta Region 1-877-628-9613
• DCH Medicaid Member Services 1-866-211-0950
• Georgia DFCS Customer Service 1-877-423-4746
• Georgia Gateway 1-877-423-4746
• GeorgiaCares (SHIP) 1-866-552-4464
• Medicare 1-800-MEDICARE (1-800-633-4227)
• Medicare Rights Center 1-800-333-4114
• Center for Medicare Advocacy 1-860-456-7790
• Justice in Aging 202-289-6976
• Atlanta Legal Aid Senior Citizens Law Project 404-377-0701
• Georgia Legal Services Program 1-800-498-9469
• Senior Medicare Patrol Georgia: contact through GeorgiaCares 1-866-552-4464
• 211 Georgia
• Eldercare Locator 1-800-677-1116
• AARP Georgia 1-866-295-7283
• BenefitsCheckUp (National Council on Aging) at benefitscheckup.org
• Benefit Bank of Georgia :::

This guide is provided by Brevy (brevy.com) as a public education resource. It does not constitute legal, medical, or financial advice. Medicare LIS rules, income and resource limits, and benefit amounts change annually. For specific guidance on your situation, consult the agencies and organizations listed above, including GeorgiaCares (1-866-552-4464) for free unbiased counseling, or speak with a licensed Medicare agent. Last verified May 13, 2026.